Search PubMed⌕ Search

Biomedical subjects

Sabina De Geest

Publications and source records attributed to Sabina De Geest.

At least 37 records · Page 2Linked to original sources
PubMed2005

Growing pains: non-adherence with the immunosuppressive regimen in adolescent transplant recipients.

One-year graft and patient survival are better in adolescent transplant recipients (age 11-19 years) than in younger (age < 11 years) pediatric transplant recipients. However, several groups found that long-term outcomes (> i.e. 5 year post-transplant) in the adolescent age group are significantly worse than in younger transplant recipients. A behavioral factor that could explain an important part of the poorer clinical outcome in adolescent transplant recipients is non-compliance with medication taking. Adolescents, like all organ transplant recipients irrespective of their age, must adhere to a life-long immunosuppressive regimen in addition to other aspects of their therapeutic regimen. Therefore, adolescent transplant recipients, as all transplant patients, should be regarded as a chronically ill patient population in whom behavioral and psychosocial management is equally important as state-of-the-art medical management. This paper provides an overview of the current knowledge on prevalence, clinical consequences, and risk-factors for non-compliance with the immunosuppressive regimen in adolescent transplant recipients and offers some suggestions for adolescent-tailored interventions to improve medication adherence.

Adolescent↗
PubMed2005

Prevalence of prednisolone (non)compliance in adult liver transplant recipients.

Limited evidence is available concerning (non)compliance with the immunosuppressive regimen in adult liver transplant recipients. In our study we prospectively assessed prednisolone (non)compliance in 108 adult liver transplant recipients using electronic event monitoring (EEM) in an outpatient setting. The EEM is a pill bottle fitted with a cap containing a microelectronic circuit that registers date and time of bottle openings and closings. Median taking compliance was 100% (range 60-105%), median dosing compliance was 99% (range 58-100%); median timing compliance (TIC) was 94% (42-100%). A drug holiday (DH) of > or =48 h was found in 39% of the patients of > or =72 h in 16% of the patients. Using EEM in liver transplant recipients, we found an overall high level of compliance for prednisolone, except that TIC was low in about one third of the patients. Age below 40 years was found a significant risk factor for decreased TIC and for DHs of > or =48 h.

Adult↗
PubMed2005

Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review.

This literature review summarizes the evidence on the prevalence, determinants, clinical and economic consequences of nonadherence with immunosuppressive drugs in renal transplant patients. A literature search yielded 38 articles measuring nonadherence by self-report, collateral report, assay, refill prescriptions or electronic monitoring. The weighted mean prevalence of self-reported nonadherence was 28%. Nonadherence is associated with poor clinical outcomes, contributing to 20% of late acute rejection episodes and 16% of the graft losses (weighted means). In addition, nonadherence results in lower lifetime costs because of shorter survival, yet also in a lower number of quality adjusted life years. Consistent determinants of nonadherence were younger age, social isolation, and cognitions (e.g. low self-efficacy, certain health beliefs). Determinants concerning the health care system/team seem to be under-investigated. Because the evidence summarized in this review is based on older immunosuppressive regimens, further research should focus on prevalence, determinants and consequences of nonadherence with newer immunosuppressive regimens.

Adult↗
PubMed2004

Individual quality of life in adults with congenital heart disease: a paradigm shift.

AIMS: During the last decade, a paradigm shift has emerged in the measurement of quality of life, from the use of standard questionnaires towards a more individualized approach. Therefore, this study examined individual quality of life in adults with congenital heart disease and explored potential differences with those reported by matched, healthy control subjects. METHODS AND RESULTS: We examined 579 adults with congenital heart disease. A subsample of 514 of these patients was matched for age, gender, educational level, and employment status with 446 healthy counterparts. Individual quality of life was assessed using the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW). Twelve domains affecting patients' quality of life were identified. Family, job/education, friends, health, and leisure time were the most prominent quality of life domains. Significantly fewer patients than control subjects considered financial means and material well-being and future to be important determinants of quality of life. CONCLUSION: Assessment of quality of life in adults with congenital heart disease that focusses on the individual is appropriate for obtaining in-depth information on issues relevant for patients' quality of life. This represents a paradigm shift in the measurement of this concept.

Adolescent↗
PubMed2004

Prevalence and correlates of depression symptoms at 10 years after heart transplantation: continuous attention required.

This study investigates the presence and correlates of symptoms of depression at 5 and 10 years after heart transplantation, with particular attention given to patients showing symptoms at both time points. Prevalence of depression symptoms were studied in 41 patients, prospectively, at 5 and 10 years after heart transplantation. We examined potential correlates of depression symptoms (i.e. worse functional capacity, inadequate coping mechanisms and lack of social contacts) 10 years after transplantation. The prevalence of depression symptoms was 30% at 5 years and 22% at 10 years. Of the 41 patients, 20% were depressed at both time points. Those patients had significantly higher scores on passive coping and had significantly lower club membership. They also tended to have more negative emotions (i.e. anger, hostility and irritability) and less engagement in sports activities. Functional capacity was not different. Depression symptoms were prevalent and persistent in the long-term after heart transplantation. This study opens perspectives for beyond-standard pharmacological and psychotherapeutic treatment for depression, i.e. training patients who are using passive coping to use problem-solving capacities instead and motivating them to engage in social life and sports activities.

Adaptation, Psychological↗
PubMed2004

Validity, reliability and responsiveness of the "Schedule for the Evaluation of Individual Quality of Life-Direct Weighting" (SEIQoL-DW) in congenital heart disease.

BACKGROUND: The 'Schedule for the Evaluation of Individual Quality of Life-Direct Weighting' (SEIQoL-DW) is an instrument developed to measure individual quality of life. Although this instrument has been used in numerous studies, data on validity and reliability are sparse. This study aimed to examine aspects of validity, reliability and responsiveness of the SEIQoL-DW on data obtained in adults with congenital heart disease, by using the new standards of psychological testing. METHODS: We evaluated validity evidence based on test content, internal structure, and relations to other variables, as well as the stability and responsiveness of the SEIQoL-DW. Evidence was provided by both theoretical considerations and empirical data. Empirical data were acquired from two studies. Firstly, using a cross-sectional study design, we included 629 patients with congenital heart disease. Secondly, 130 of the 629 initially included patients readministered the questionnaires approximately one year after the first data collection. In addition to the SEIQoL-DW, linear analog scales were used to assess overall quality of life and perceived health. RESULTS: We found that the SEIQoL-DW is not a valid measure of quality of life, but rather assesses determinants that contribute to individuals' quality of life. The SEIQoL-DW consistently proved to be valid and reliable to assess those determinants. However, responsiveness in patients with congenital heart disease may be problematic. CONCLUSION: Based on theoretical and empirical considerations, the SEIQoL-DW cannot be considered as a quality of life instrument. Nonetheless, it is a valid and reliable instrument to explore determinants for patients' quality of life.

Adaptation, Psychological↗
PubMed2004

Development of a risk assessment tool for deliberate self-extubation in intensive care patients.

OBJECTIVE: To develop a risk stratification scheme for deliberate self-extubation in intensive care patients. DESIGN: A nested case-control study. SETTING: Four surgical ICUs, one medical ICU, one coronary care unit, and one emergency department of a tertiary care center. MEASUREMENT: In a 3-month period, the number of ventilation periods, ventilation days, and unplanned extubations were recorded. Potential determinants of unplanned extubation were assessed with a translated (English to Dutch) and modified version of the "Unplanned Extubation Data Collection Tool." PATIENTS: Clinical and demographic characteristics and circumstances of the 26 unplanned extubations were compared with those of 48 randomly selected control patients who did not experience unplanned extubation. RESULTS: The incidence of unplanned extubation was 4.2%, corresponding to 0.68 unplanned extubations per 100 ventilation days. The incidence was substantially lower at surgical ICUs (2.6%) compared with that at medical ICU/CCUs (9.5%). Multiple logistic regression analysis revealed that patients with a low sedation level (Bloomsbury Sedation Score) and a higher degree of consciousness (Glasgow Coma Scale) were at higher risk for deliberate self-extubation. The explained variance of this model including these factors was 67.3%. CONCLUSION: Based on the risk factors identified, a risk assessment tool was developed. Systematic administration of the Bloomsbury Sedation Score and the Glasgow Coma Scale, and the use of the stratification scheme, allows identification of patients at risk. Appropriate reduction of sedative drugs during weaning, a timely extubation, and increased surveillance in patients identified to be at risk are possible interventions to diminish the number of unplanned extubations.

Adult↗
PubMed2004

Stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy: Swiss HIV cohort study.

OBJECTIVES: To explore the association between a stable partnership and clinical outcome in HIV infected patients receiving highly active antiretroviral therapy (HAART). DESIGN: Prospective cohort study of adults with HIV (Swiss HIV cohort study). SETTING: Seven outpatient clinics throughout Switzerland. PARTICIPANTS: The 3736 patients in the cohort who started HAART before 2002 (median age 36 years, 29% female, median follow up 3.6 years). MAIN OUTCOME MEASURES: Time to AIDS or death (primary endpoint), death alone, increases in CD4 cell count of at least 50 and 100 above baseline, optimal viral suppression (a viral load below 400 copies/ml), and viral rebound. RESULTS: During follow up 2985 (80%) participants reported a stable partnership on at least one occasion. When starting HAART, 52% (545/1042) of participants reported a stable partnership; after five years of follow up 46% (190/412) of participants reported a stable partnership. In an analysis stratified by previous antiretroviral therapy and clinical stage when starting HAART (US Centers for Disease Control and Prevention group A, B, or C), the adjusted hazard ratio for progression to AIDS or death was 0.79 (95% confidence interval 0.63 to 0.98) for participants with a stable partnership compared with those without. Adjusted hazards ratios for other endpoints were 0.59 (0.44 to 0.79) for progression to death, 1.15 (1.06 to 1.24) for an increase in CD4 cells of 100 counts/microl or more, and 1.06 (0.98 to 1.14) for optimal viral suppression. CONCLUSIONS: A stable partnership is associated with a slower rate of progression to AIDS or death in HIV infected patients receiving HAART.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Caliber of quality-of-life assessments in congenital heart disease: a plea for more conceptual and methodological rigor.

BACKGROUND: Interest in quality-of-life issues in children, adolescents, and adults with congenital heart disease has increased significantly during the past decades. In general, quality-of-life research is stimulated by an overall interest in outcomes. More specifically, quality-of-life studies add to mortality and morbidity data by taking reported physical, psychological, and social problems into consideration. However, quality of life can be an ambiguous concept that is hindered by methodological weaknesses, a situation that can prevent the drawing of firm conclusions. OBJECTIVE: To appraise the conceptual and methodological rigor of published quality-of-life assessments in patients with congenital heart disease. DESIGN: A review of 70 articles published in the medical literature, using the 10 criteria previously developed by Gill and Feinstein. For each criterion, the number of articles complying with that criterion was counted, and the percentage was calculated. To indicate how well individual articles performed on the respective criteria, a summary score was calculated by summing the number of criteria an article fulfilled and dividing this sum by the number of criteria for which the article was eligible to be evaluated; the resulting value was then multiplied by 100. MAIN OUTCOME MEASURE: Summary scores ranging from 0, for articles complying with none of the criteria, to 100, for articles complying with all of the criteria. RESULTS: We found that quality-of-life assessments in patients with congenital heart disease showed major conceptual and methodological drawbacks (median summary score, 0). Moreover, we found that the term quality of life was often used inappropriately, an observation supported by several articles in which the authors drew conclusions about patients' quality of life, even though quality of life was not specifically measured. CONCLUSIONS: A poor conceptual and methodological basis for quality of life implies that many results from quality-of-life studies performed in patients with congenital heart disease contribute little to the scientific knowledge base of quality of life in this patient population. Future quality-of-life studies need to invest in a rigorous conceptualization, an adequate operational definition, and a sound measurement of quality of life.

Adolescent↗
PubMed2004

A survey of coronary risk factors and B-type natriuretic peptide concentrations in cardiac nurses from Europe: do nurses still practice what they preach?

BACKGROUND: From a previous survey of cardiac nurses attending a scientific conference, we learned that these nurses adopted a healthier lifestyle than the general population. AIMS: The aim of this study was to determine the overall profile of cardiac risk factors in a similar cohort and determine whether cardiac nurses continue to 'practice what they preach' in this regard. Secondly, we examined the practical value of screening a large cohort of individuals within a short time frame (total of 8 hours screening time) and determined the range of BNP concentrations within a 'healthy' cohort. METHODS: Data on CHD risk factors were collected with a short self-report questionnaire. The sample consisted of 122 cardiac nurses from 19 countries attending a European cardiac nursing conference held in Stockholm. A venous blood sample was collected into a tube containing potassium ETDA. B-type natriuretic peptide was measured on-site with the use of a portable fluorescence immunoassay kit. RESULTS: Most participants were female (89%). Participants ranged in age from 23 to 60 years with a mean age of 41 (S.D. 9.4). Eleven percent - all female - reported they were current smokers, 27% (34) had a BMI >25 and 27% of the sample stated they did not exercise regularly. Almost half (48%) of the sample reported a family history of CHD. As expected, all BNP-values were within the normal range. There were significant differences in BNP on the basis of sex (P<0.05) and age (P<0.05) and a trend towards increasing BNP concentrations with progressively higher BMI scores (P=0.06). CONCLUSION: This study reconfirms the likelihood that many cardiac nurses heed their own advice on lifestyle modification to reduce cardiovascular risk and therefore provide a good role model for the promotion of primary and secondary prevention initiatives.

Adult↗
PubMed2004

Complexity in caring for an ageing heart failure population: concomitant chronic conditions and age related impairments.

The complexity of caring for the ageing heart failure (HF) population is further complicated by concomitant chronic conditions (i.e., polypharmacy, depression), age related impairments (i.e., hearing, visual and cognitive impairments, impairments in activities of daily living (ADL/IADL), and other issues (e.g., health illiteracy, lack of social support). This paper provides an overview of these risk factors, outlines how they individually and in interplay endanger favourable outcome by putting patients at risk for poor self-management. Moreover, suggestions are made on how these issues could be addressed and integrated in heart failure management by applying gerontological care principles in caring for the ageing heart failure population.

Activities of Daily Living↗
PubMed2004

Effect of late medication non-compliance on outcome after heart transplantation: a 5-year follow-up.

BACKGROUND: Although non-compliance with immunosuppression therapy is increasingly recognized as a risk factor for morbidity and mortality after heart transplantation (HTX), evidence for this association is limited to 1 prospective study that assessed medication non-compliance in the early post-HTX period and used self-report. The current prospective HTX cohort study explores the predictive value of late non-compliance (>1 year after HTX) during a 5-year follow-up using the Medication Event Monitoring System (MEMS) for compliance assessment. METHODS: We categorized 101 patients (86% men; aged 55 +/- 10 years; time after HTX at inclusion, 1,253 +/- 534 days) as medication non-compliers (n = 17) or compliers (n = 84) based on the MEMS. Late acute rejections, transplant coronary artery disease (TxCAD), retransplantation, and death were registered during the 5-year follow-up. RESULTS: Non-compliers had significantly more TxCAD (p = 0.025). Non-compliers also had a greater rate of late acute rejection (11.8% vs 2.4%) and retransplantation (13.3% vs 2.5%)), although these differences were not statistically significant. Mortality rates were similar. Kaplan Meier analysis showed that non-compliers had a significantly shorter clinical-event-free time compared with compliers (mean, 1,318 vs 1,612 days; p = 0.043). Cox regression analysis showed that the adjusted relative risk associated with non-compliance was 2.03 (p = 0.0582), after controlling for other known transplant-related risk factors for poor clinical outcome. CONCLUSION: The current study demonstrates that medication non-compliance in the late post-transplant period doubles the risk for an untoward clinical event. Non-compliance is a continuous risk factor after heart transplantation that should be targeted by compliance-enhancing interventions.

Adult↗
PubMed2004

The Strain of Care for Delirium Index: a new instrument to assess nurses' strain in caring for patients with delirium.

This study evaluated content validity, internal consistency and construct validity of the Strain of Care for Delirium Index (SCDI), a newly constructed instrument to measure the strain nurses experience in caring for patients with delirium. Content validity, evaluated by eight experts, reduced the initial pool of items from 38 to 28. Using a convenience sample of 190 nurses, Cronbach's alpha for the 28-item version was 0.88. Using non-linear principal components analysis another eight items were eliminated and a four-factor structure was identified. The proportion of variance explained by the remaining 20 items was 61.51%. Preliminary psychometric evaluation of the SCDI supported content validity, internal consistency and construct validity; however additional psychometric evaluation is warranted.

Adult↗
PubMed2004

The economic implications of non-adherence after renal transplantation.

BACKGROUND: The economic impact of therapeutic non-adherence in chronic diseases has rarely been examined using qualitative standards for economic evaluation. This study illustrates the impact of non-adherence on the cost utility of renal transplantation versus haemodialysis from the societal perspective and examines the scope for adherence-enhancing interventions. METHODS: Long-term costs and outcomes in adherent and non-adherent renal transplant patients were simulated in a Markov model. The cost (euros, year 2000 values) and outcome data that were imputed in the model were derived from a prospective study in renal transplantation candidates performed in 2002. Probabilities of adverse events, graft rejection, graft loss and death in adherent and non-adherent renal transplant patients were derived from literature. RESULTS: Compared with dialysis, renal transplantation offers a better outcome in both adherent and non-adherent patients. Lifetime costs after transplantation in the adherent patient group are higher than lifetime dialysis costs and lifetime costs in the non-adherent patient group, mainly because adherent patients live longer after transplantation. Long-term outcomes after transplantation are better for adherent than for non-adherent patients. The mean cost per QALY gained in adherent patients relative to non-adherent patients was euro 35 021 per QALY (95% CI 26 959, 46 620). CONCLUSION: Compared with established healthcare interventions, such as haemodialysis, renal transplantation can be considered a cost-effective therapy for patients with end-stage renal disease, even if patients are non-adherent after transplantation. The low incremental cost per QALY calculated in this model for adherent renal transplant patients, suggests there may be scope for adherence-enhancing interventions (provided that such interventions with a sufficiently high effectiveness exist or can be developed). As the findings are based on simulated long-term costs and outcomes, they should not be considered as precise estimates of the impact of non-adherence. This study is rather meant as an illustration of how non-adherence may impact on the results of cost-effectiveness analyses.

Cost-Benefit Analysis↗